Hypertension and diabetes: poor care for patients at community health centres.
OBJECTIVE
To identify health care provider-related determinants of diabetes and hypertension management in patients attending public sector community health centres (CHCs).


METHODS
A random sample of 18 CHCs in the Cape Peninsula providing hypertension and diabetes care was selected. Twenty-five patients with diabetes and 35 with hypertension per clinic were selected and interviewed by trained fieldworkers, and their medical records were audited. Regression analyses identified predictors of controlled hypertension (< 140/90 mmHg) and diabetes (HbA1c < 7%). In-depth interviews with nurses and doctors explored their experiences in working at the CHCs. Height, weight and blood pressure (BP) were measured for all patients and random blood samples collected for lipids, glucose, HbA1c and creatinine.


RESULTS
Of the participants 923 had hypertension and 455 diabetes (289 had both conditions). Of the hypertensive patients 33% had a BP < 140/90 mmHg, while 42% of the patients with diabetes had non-fasting glucose levels below 11.1 mmol/l. Patients' knowledge about their conditions was poor. Prescriptions for drugs were not recorded in medical records of 22.6% of the patients with diabetes and 11.4% of those with hypertension.


CONCLUSIONS
Primary care for patients with hypertension and diabetes at public sector CHCs is suboptimal. This study highlights the urgent need to improve health care for patients with these conditions in public sector clinics in the Cape Peninsula.
Steyn
Krisela
K
Department of Medicine, University of Cape Town. krisela.steyn@mrc.ac.za
Levitt
Naomi S
NS
Patel
Maya
M
Fourie
Jean
J
Gwebushe
Nomonde
N
Lombard
Carl
C
Everett
Kathy
K
D003153:Community Health Services / Q000592:standards*; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000592:standards*; D017150:Public Sector; D012044:Regression Analysis; D013019:South Africa